The Journal of family practice
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Multicenter Study Comparative Study
Practice variations between family physicians and obstetricians in the management of low-risk pregnancies.
Studies suggest that family physicians and other generalist physicians practice differently than specialists. This study was performed to determine whether practice patterns and outcomes differ for women with low-risk pregnancies who obtain maternity care from family physicians as compared with those who are cared for by obstetricians. ⋯ Women obtaining maternity care from family physicians were less likely to receive epidural anesthesia during labor or an episiotomy after vaginal births, and had a lower rate of cesarean section delivery rates, primarily because of a decreased frequency in the diagnosis of cephalopelvic disproportion. Differences between outcomes persisted after adjustment for potential confounders such as parity, previous cesarean delivery, and use of epidural anesthesia during labor. No differences between the two physician groups with respect to neonatal outcomes were found.
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Epidural anesthesia, although effective, has been associated with changing the course of labor. Previous studies have been criticized for not pinpointing the factors determining the use of epidural anesthesia. The purpose of this study was to determine the effect of epidural anesthesia use on the course of labor. ⋯ The average length of the second stage of labor is significantly longer for women who receive epidural anesthesia. The rate of epidural anesthesia use in this study population was strongly influenced by a change in health-care financing.
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Comparative Study
A multivariate model for specialty preference by medical students.
Numerous studies have demonstrated differences among students regarding their preference of a medical specialty. The goal of the present research was to develop a model for the selection of a primary care specialty (ie, family practice, general internal medicine, medicine/pediatrics, and general pediatrics). ⋯ No single factor dominates a student's preference for primary care. Students preferring primary care were most strongly influenced by their perceptions of practice variations. Students preferring nonprimary care specialties were more interested in income, prestige, and hospital-based practice. Medical school faculty had no significant impact on the preferences of either group of students.
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Those who must make health care decisions on behalf of persons who lack decision-making capacity often have too little information. The purpose of this study was to determine whether and to what degree sociodemographic factors, social support, religious involvement, and functional status served as predictors of the health-related values and preferences of geriatric patients. ⋯ Sociodemographic and functional status variables are relatively weak predictors of personal values and directives. This reinforces the importance of routinely eliciting patient values and preferences and of updating the information, particularly following changes in functional status or family support. Baseline information regarding the health-related values and preferences of this primary care geriatric clinic population may provide valuable information about the values and preferences of decisionally impaired older patients.